【作者】 张剑；

【导师】 王虎山；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 目的：观察围术期应用乌司他丁对急性下肢缺血再灌注致血管内皮细胞损伤的影响。方法：将40例急性股动脉栓塞手术取栓患者,ASA I-Ⅲ级，随机分为缺血/再灌注组(C组，n=20),乌司他丁治疗组(U组，n=20）。患者入室后建立静脉通路，同时抽取静脉血4ml备用。取血后U组静脉注射20万单位UTI（生理盐水稀释至20ml），C组在相同时刻静脉给予20ml生理盐水。对患者实施硬膜外麻醉，确定麻醉效果后行股动脉切开取栓术。常规持续监测心率（HR）、血压(BP)、脉搏氧饱和度(SpO2)、呼吸频率(RR)。术中动脉再通即时U组静脉追加20万单位UTI（生理盐水稀释至20ml），C组在相同时刻静脉注射20ml生理盐水。术后在动脉再通12h时、24h时U组将20万单位UTI溶于100ml生理盐水静点，C组于相同时间静点生理盐水100ml。分别于首次次静脉注射UTI前（T0）、取栓后30min（T1）、第12（hT2）、第24h(T3)、第3天（T4）、第7天（T5）抽取肘正中静脉血测定血浆丙二醛（MDA）浓度、肌酸激酶(CK)活性、循环内皮细胞计数(CEC)。结果：①两组年龄、性别构成、体重、缺血时间和手术时间差异均无统计学意义（P>0.05）。②与T0时相比较, C组MDA值在T1-4时升高（P<0.05或P<0.01），U组MDA值在T2-4时显著升高（P<0.01）；C组CK活性在T1-4时升高（P<0.05或P<0.01），U组CK活性在T1-3时升高（P<0.05或P<0.01），而在T5时显著降低（P<0.01）；C组CEC值T1-4时升高（P<0.05或P<0.01），U组CEC值在T1-2时升高（P<0.05或P<0.01），而在T5时显著降低（P<0.01）。③与C组相比较，U组MDA值在T2-4时显著降低（P<0.01）；U组CK活性在T1-5时显著降低（P<0.01）；U组CEC值在T1-4时显著降低（P<0.01），在T5时降低（P<0.05）。结论：围术期应用乌司他丁能减轻急性下肢缺血再灌注损伤所致的血管内皮细胞损伤。更多还原

【Abstract】 Objective: To investigate the effect of using Ulinastatin perioperatively onthe injury of Vein Endothelial cells caused by Ischemia-Reperfusion injury oflower extremity.Methods: Fourty ASA I-Ⅲ patients undergoing embolectomy after acutefemoral artery embolization。They were randomly divided into C group (controlgroup) and U group (Ulinastatin group), n=20.Once the patients got into theoperating room, we draw blood4ml from their veins. U group receivedintravenous Ulinastatin20U before the start of operation, while C groupreceived intravenous same capacity normal saline as control. Epiduralanesthesia was used to all the patients. The operation began after determiningthe final effect of the anesthesia.Blood pressure(BP), pulse oxygensaturation(SPO2) and heart rate (HR)were monitored continuously.During thesurgery when the artery blood flow was restored, U group received intravenousUlinastatin200,000U again, C group received intravenous same capacitynormal saline as control. Twelve hours and twenty-four hours after the restoringof the artery flow，we gave additional200,000U Ulinastatin to the patients ofthe U group respectively,and gave same volume normal saline to the patientsof the C group. Venous blood is collected at six time points:T0(the first time thepatients received intravenous Ulinastatin),T1(thirty minutes after removing theembolus),T2(twelve hours after the operation),T3(twenty-four hours after theoperation),T4(the third day after the operation),T5(the seventh day after theoperation).By processing the blood samples,we detected the data of the MDA’sconcentration, the CK’s activity and the CEC’s numerical value at every time point. Then measure the data using statistical treatment.Results:①There was no significant difference in ages, sex, weight,ischemia time of the lower extremity and length of operation(P>0.05).②Compared with T0, the concentration of MDA in C group increased at T1-4（P<0.05or P<0.01），and in U group increased significantly at T2-4（P<0.01）；the activity of CK in C group increased at T1-4（P<0.05or P<0.01），and in Ugroup increased significantly at T1-4（P<0.01），but decreased significantly at T5（P<0.01）；the numerical value of CEC in C group increased at T1-（4P<0.05orP<0.01），in U group increased at T1-2（P<0.05or P<0.01），but decreasedsignificantly at T5（P<0.01）。③Compared with C group，the concentration ofMDA decreased significantly at T2-4（P<0.01）；the activity of CK decreasedsignificantly at T1-5（P<0.01）；the numerical value of CEC decreasedsignificantly at T1-4（P<0.01），decreased at T5（P<0.05）。Conclusion: Using Ulinastatin perioperatively can reduce the injury ofVein endothelial cells caused by Ischemia-Reperfusion injury of the lowerextremity.更多还原